Causes of Tension Headache: What Sets the Band Off

The short answer about the causes of tension headache is that nobody knows the whole of it yet. That surprises people. It is the most common headache there is, and most of us have had one. Yet the exact chain of events, from a long day to a band of pressure around the head, is still being worked out. What we do have is a reliable list of triggers, a fair picture of what the muscles are doing, and a growing sense that the nervous system's own pain processing is part of the story.

I teach the Feldenkrais Method®, so I meet tension headaches from a particular angle: how a person holds their jaw, eyes, shoulders and breath across a day. This page sets out what is known, what is only likely, and what needs a doctor rather than a trigger list.

Why the causes of tension headache are still debated

For a long time these were called muscle contraction headaches. The idea was simple. Tight muscles in the scalp, neck and shoulders squeezed, and the squeeze hurt. The name later changed to tension type headache, partly because the simple idea did not hold up. People with tension headaches often do have tender spots in the muscles around the head and neck. But the amount of muscle tension does not line up neatly with the amount of pain. Some people with very tight necks never get headaches. Some people with soft, easy necks get them often.

The current picture has two layers. The first is the edge of the body: the muscles, the joints of the neck, the jaw, the eyes. The second is the nervous system itself. In people who get frequent tension headaches, the parts of the brain and spinal cord that handle pain seem to become more sensitive over time. A signal that once went unnoticed now registers as an ache. That is one reason a headache can arrive on a day when nothing felt especially tense.

The World Health Organization keeps the language plain. It describes tension type headaches as pressure or tightness, often like a band around the head, which may be stress related or linked to musculoskeletal problems in the neck. The same fact sheet notes that medication overuse headache, a separate pattern driven by frequent painkiller use, may affect up to 5% of some populations (WHO, 2025). I will come back to that one, because it matters.

Common causes of tension headache people and clinicians name

Nobody can hand you a single cause. What exists instead is a shortlist of triggers that turn up again and again, in clinic notes and in headache diaries. Most people find two or three of them in their own week.

Stress. The most named trigger by a distance. Stress tends to raise the low level holding in the jaw, scalp and shoulders without you deciding anything. It also seems to turn up the volume on pain processing. That is why a stress headache often lands late in a hard day, or on the first quiet evening after one.

Short or broken sleep. A bad night is one of the most reliable triggers people report. Sleep and headache also run in both directions. Pain makes sleep lighter, and light sleep lowers the threshold for pain. If your headaches are there on waking, our explainer on why you wake up with a headache looks at what the night may be doing.

Long hours in one position at a screen. The neck was built to move, and it copes less well with being held still. An hour of the head carried a little forward keeps the muscles at the back of the neck working without a break. By mid afternoon they are tired and tender.

Eye strain. Reading small text, squinting into glare, or working in dim light asks the small muscles around the eyes to hold effort for hours. Many people feel that effort as pressure across the forehead and behind the eyes.

Jaw clenching. The muscles that close the jaw run up over the temples. Clench for an afternoon, or grind through a night, and those muscles can be sore afterwards. Our explainer on whether clenching your jaw can cause headaches goes into this one in detail.

Skipped meals and dehydration. A long gap without food or water is a common trigger, and an easy one to miss on a busy day.

Frequent painkiller use. This one catches people out. Painkillers taken for headaches on many days, over months, can start to drive a headache of their own. Clinicians call it medication overuse headache. It feels much like the headache you were treating, so it is easy to keep reaching for the same packet. If you notice you take something for your head on most days of the week, please raise it with your doctor or pharmacist. We give no advice here on how much or how often to take anything. That conversation belongs with a professional who knows your history.

Muscle tenderness is part of the causes of tension headache, not all of it

When I press gently along the base of someone's skull, or into the top of their shoulders, they often wince. That tenderness is real, and it is one of the most consistent findings in tension type headache. So it is tempting to say the muscles are the cause and leave it there.

The trouble is the mismatch I mentioned above. Tenderness and pain do not rise and fall together in a tidy way. The more careful view is that sore muscles send a steady low signal, and a sensitised nervous system turns that signal into an ache. Both layers matter. Working only on the muscles, with heat or massage, helps many people for a while. Working only on the stress leaves the sore muscles in place. The people I see tend to do best when both get some attention. Our Feldypedia entry on tension headaches goes further into how posture, stress, and the jaw and neck feed the pattern.

Noticing your own pattern: a Feldenkrais view

Here is what I actually do with people who get these headaches. I do not give them a list of rules. I ask them to become curious about four things across an ordinary day: the jaw, the eyes, the shoulders, and the breath.

Where are your back teeth right now? For many people reading this, they are touching. A resting jaw has a small gap between the teeth. Are your eyes gripping the screen, or can they soften and still read? Are your shoulders somewhere near your ears? Is your breath high and short, or does the belly move a little?

This is not a test. The point is to notice what you do, several times a day, without judgement. The noticing alone often changes things. A clench that is noticed tends to soften. A breath that is noticed tends to lengthen on its own.

The second piece is variety. Long positions are a trigger, so the answer is not a better position held for longer. It is a position that changes. Let the head turn slowly a few degrees and come back. Let the eyes travel to the far wall and return. Let one shoulder drop, then the other. Lean back in the chair for two breaths. Small, frequent changes, not one big one.

For a guided version of this kind of attention, our somatic exercises for sleep page offers a short lying down lesson for the end of the day. It is built for settling a busy body, which is exactly the state that feeds a stress headache. Feldy, the online movement program I built around this work, includes lessons for the jaw, neck, eyes and breath, and you can see how it works for stress and sleep.

When a headache needs a doctor, not a trigger list

Most tension headaches are a nuisance rather than a danger. A few headaches are not, and they need a different page from this one.

Call emergency services for a headache that arrives suddenly and severely, the kind people describe as the worst of their life. Do the same for a headache that comes with weakness, numbness, confusion, or a change in your speech or vision. Get urgent care for a headache after a knock to the head, for a headache with fever and a stiff neck, or for a new kind of headache that starts after the age of 50.

For ordinary headaches, book an appointment if they are becoming more frequent, if the pattern has changed, if they are not easing with rest, or if you are taking painkillers on many days. Movement and awareness sit alongside that care. They do not replace it.

Find where to start

Tension headaches have several possible drivers, and people differ in which one leads. Some settle when the jaw gets attention. Some settle when the day gets more movement in it.

Not sure which movement method fits you? Take the 60 second Movement Match quiz: four short questions, and it points you toward one movement method that suits how you carry tension.

Common Questions about the causes of tension headache (FAQ)

What causes tension headaches?

Nobody knows the full answer yet. Tender muscles around the head and neck are common, and a nervous system that has become more sensitive to pain seems to play a part as well. On top of that sit everyday triggers such as stress, short sleep, long screen hours, eye strain, jaw clenching, missed meals and frequent painkiller use.

What are the most common tension headache triggers?

Stress is named most often. After that come poor or short sleep, long hours held in one position at a screen, eye strain, clenching the jaw, skipping meals or not drinking enough, and taking painkillers on many days. Most people find two or three of these in their own week rather than one.

Why does stress cause a tension headache?

Stress raises the quiet holding in the jaw, scalp and shoulders without you choosing it, and it seems to turn up the nervous system's sensitivity to pain. Both changes make a headache more likely. Many people notice a stress headache arrives late in a hard day, or in the first quiet hour after it.

Can painkillers cause tension headaches?

Yes, when they are taken for headaches on many days over months. Clinicians call this medication overuse headache, and it feels much like the headache you were treating. If you take something for your head most days, talk with your doctor or pharmacist. This page gives no advice on doses or how often to take anything.

Is gentle movement safe when I have a tension headache?

Usually, yes. Small, slow movements of the neck, eyes and shoulders, kept well within comfort, are what most people with an ordinary tension headache can manage. Skip movement and seek care instead if the headache comes on suddenly and severely, starts after a blow to the head, or arrives with fever, a stiff neck, weakness, confusion, or changes in vision or speech.

How often should I check my own tension pattern?

A few times a day is plenty. Tie it to things that already happen, such as every time you open an email or stand up from the desk. Each check takes a few seconds: where are the teeth, where are the shoulders, how is the breath. Short and frequent works better than one long session.

How long until I notice fewer tension headaches?

It varies, and nobody can promise a result. Some people notice fewer late day headaches within a couple of weeks of changing how long they sit still and how often they check the jaw. For others the pattern shifts over a few months. If nothing changes, or headaches grow more frequent, see a doctor.

How is a tension headache different from a cervicogenic headache?

A tension headache is usually felt on both sides, like a band, and is not set off by one particular neck movement. A cervicogenic headache starts in the structures of the neck, is usually on one side, and is often brought on by turning the neck or pressing on it. A clinician can tell them apart, and the two can overlap.

What is the best way to find my own tension headache triggers?

A simple diary for three or four weeks. Note the time a headache starts, how you slept, how long you sat at a screen, what you ate and drank, whether you caught yourself clenching, and any painkillers. Patterns often show up by the third week. Take the diary to your doctor if you want a second pair of eyes on it.

What should I avoid if I get tension headaches often?

Avoid long unbroken spells at a screen with no change of position. Avoid skipping meals and going hours without water. Avoid relying on painkillers on most days without a doctor knowing. Avoid pushing a tight neck hard, since forced movement tends to add holding rather than ease it.

When should I see a doctor about tension headaches?

Call emergency services for a sudden, severe headache, or one with weakness, numbness, confusion, or changed speech or vision. Get urgent care after a head injury, with fever and a stiff neck, or for a new headache pattern after 50. For ordinary headaches, see a doctor if they are getting more frequent, have changed, do not ease with rest, or need painkillers on many days.

The cause may not be fully known, but your own pattern is knowable. A jaw that is noticed, a screen hour that is broken up, a night that is protected: these are small, and they are the places where many people find their headaches start to loosen their grip.